Bed-related falls constitute one-third of all falls in nursing homes. The consequences of fall-related injury include hospitalization, physical deterioration and increased mortality. The proposed study will assess the relationship using multiple logistic regression between bed-related falls/injuries with sleep alterations in general, and with nighttime pain and discomfort, a specific remediable factor likely to be uncovered in this study as a strong contributor to sleep alterations. To meet this objective, we propose to extend a currently NIA-funded nursing home study testing the effectiveness of a multi-faceted behavioral intervention on sleep nursing home residents by pain/discomfort among cognitively-impaired residents via a comprehensive Advanced Practice Nurse clinical evaluation; (2) To determine the absolute and relative role of uncontrolled nighttime pain and discomfort in increasing the risk of sleep alterations among cognitively-impaired residents via a comprehensive residents accounting for other physiological (demographics, functional/medical status), psychological (cognition, depression) behavioral (behavioral symptoms) and environmental (nighttime noise/light levels, daytime activity level, bedtime routine and siderail use) factors; (3) To determine the impact of sleep alterations on bed-related falls/injuries controlling for other known risk factors including psychoactive drug and siderail use using data collected during an 8 month data collection period; and (4) To investigate the direct effect of pain/discomfort and other factors including use of psychoactive, pain and other medications that can effect sleep on bed-related falls among cognitively-impaired nursing home residents with and without controlling for degree of sleep disruption. The results will lead to the development of nursing interventions to address bed-related falls and injuries.